TORONTO -- Ontario is proposing major changes to its $50-billion health-care system, including monitoring the performance of doctors who are already fuming over fee cuts imposed by the Liberal government.

"This is about better co-ordinated care and a more seamless, positive experience by patients and caregivers," said Health Minister Eric Hoskins.

A Ministry of Health discussion paper suggests an expanded role for Liberal-created Local Health Integration Networks (LHINs), and shutting down the Community Care Access Centres (CCAC) created by the previous Conservative government.

The province budgets $90 million a year for the 14 LHINs, which are responsible for doling out $25 billion in spending, or half of Ontario's health-care budget.

Earlier this month, auditor general Bonnie Lysyk found none of the LHINs had ever met all of the targets in 15 performance areas, and the Liberal government responded by relaxing the targets for some of them.

"The Ministry has not developed ways to measure how effectively LHINs are performing as planners, funders and integrators of health care," said Lysyk.

The discussion paper says the LHINs would be responsible for "planning and performance management" of family doctors.

The Ontario Medical Association questioned the government's commitment to the reforms given fee cuts of nearly seven per cent imposed on doctors this year.

"Strengthening patient-focused care, which the government has indicated is a key priority of these reforms, cannot be achieved while the government continues to cut funding for physician services," said OMA president Dr. Mike Toth.

"Given the magnitude of the changes being considered and the lack of details provided, Ontario's doctors have concerns with the timeline laid out for discussion."

However, the Registered Nurses' Association of Ontario praised the discussion paper as "bold and visionary," and said shutting down the CCACs and giving LHINs more power was a good idea.

"Having two parallel bodies, each responsible for different aspects of our health system, has hindered the system's capacity to be fully integrated," says RNAO President Vanessa Burkoski.

The government wants to make it easier for people to get a family doctor, and to be able to see that primary health-care provider quickly when they are sick. It also wants to better co-ordinate care as patients move from hospitals to get treatment closer to home, while also reducing levels of bureaucracy, said Hoskins.

"Our proposal would improve communications and connections between primary health-care providers, hospitals and home and community care," he said.

The New Democrats said the discussion paper won't fix the problems in Ontario's health-care system unless the Liberals stop cutting hospital services.

"Cutting health care is not the kind of transformation that Ontarians need to see, but that's exactly what the Liberals continue to deliver," said NDP Leader Andrea Horwath.

"The government cannot seriously expect to improve care for patients while closing hospital beds, undermining trust with doctors, and forcing hundreds of layoffs."

The Ontario Hospital Association said it was eager to participate in the discussions on reforming the province's health-care system.

Nurses urged the government to quickly integrate 3,500 care co-ordinators currently working at CCACs into local health centres, family health teams and hospitals.

"Strengthening inter-professional primary care and positioning it to take on the role of care co-ordination is essential to achieving timely access and a hallmark of a high-performing health system," said the RNAO's Burkoski.

Hoskins said he hoped to introduce legislation enabling the proposed health reforms early in the new year.